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Endometriosis Care

Endometriosis is a painful gynecological disorder that affects millions of women across the world and significantly hampers with their quality of life. As this condition occurs in women mostly in their prime, it can affect their ability to get pregnant, hence causing not just physical but mental trauma.



WHAT IS ENDOMETRIOSIS?

WHAT IS ENDOMETRIOSIS?
Endometriosis is a condition wherein the tissue lining the inside of the womb, called the 'Endometrium', begins to grow outside the uterus. It is an estrogen-dependent disorder and just like in the menstrual cycle, the tissue that grows every month sheds off in the form of menstrual blood. As it does not have any way to go out, it blocks some of the areas outside the womb causing lumps or cysts. Endometriosis most commonly involves the ovaries, bowel or the tissue lining the pelvis. In rare cases, the disease could spread beyond the pelvic region and affect other parts of the body.

WHERE DOES ENDOMETRIOSIS OCCUR?

WHERE DOES ENDOMETRIOSIS OCCUR?

Endometriosis is common on the surface of the ovaries, the back of the uterus, the space between the uterus and the rectum, fallopian tubes and sometimes even near the urinary bladder. When the disease affects the ovary, large patches of endometriosis may form into cysts that may be filled with dark blood, and are therefore called 'Chocolate cysts' or 'Endometriomas'. In some rare cases, it affects scar tissue if the woman has had an operation earlier.

SYMPTOMS

SYMPTOMS

Different women suffer from different types of symptoms in endometriosis. It is often called the silent disease because many women may not experience any symptoms and therefore the disease may remain undiagnosed for a long time unless the woman undergoes specific gynaecological tests for some other problem or when she may be tested for infertility.

Some women have pelvic pain, which could sometimes be severe and the pain could increase during their menses or periods. The pain can be debilitating, reported by many as strong, sharp and paralyzing running from the pelvis down to the thighs. Others report pain in the legs and calf muscles. Whatever the nature of the pain, it interferes with the woman's regular course of living.

Since it is similar to menstrual pain, it tends to get ignored. Therefore, treatment is typically delayed and majority of affected women in India come to hospitals in an advanced stage of endometriosis. Recently, doctors have started emphasizing the need for awareness about this painful disorder so that effective measures can be taken to manage it appropriately.

There may also be pain during bowel movement and while passing urine and there could also be blood in stools in some cases. This may also be accompanied by constipation or diarrhea symptoms akin to Irritable bowel syndrome.

DIAGNOSIS

DIAGNOSIS

As research suggests, the percentage of women who come in with symptoms of endometriosis soon enough is abysmally low. In India, the stigma surrounding gynaecological disorders makes it even worse. For early detection, awareness of the disease is the key parameter. Moreover, endometriosis is often misdiagnosed as bowel disorders or ovarian cysts.

  • Pelvic examination - An experienced doctor will do a detailed assessment of the pain and other symptoms and conduct a thorough examination of the lower abdomen and pelvic region.
  • Scan - For accurate diagnosis, the doctors recommend an ultrasound scan of the pelvic area. In those with advanced disease, an MRI scan may be indicated in addition to an Xray IVU or Intravenous Urography. This is especially useful to plan the right surgical approach and involve other specialties as required during the surgery.
  • Laparoscopy - This is considered as the Gold standard in diagnosing Endometriosis. The laparoscopic procedure is done by the specialist, which involves making a key-hole incision and checking for the endometriotic growth with the help of a camera. The procedure also helps clear active lesions of endometriosis from the pelvis and abdomen.


TREATMENT

TREATMENT

There is no permanent cure for endometriosis but if accurately diagnosed at the right time, the disease can be managed with various treatments. Treatment is usually in the form of pain-relieving medications, hormone therapy or surgery.

Some women have pelvic pain, which could sometimes be severe and the pain could increase during their menses or periods. The pain can be debilitating, reported by many as strong, sharp and paralyzing running from the pelvis down to the thighs. Others report pain in the legs and calf muscles. Whatever the nature of the pain, it interferes with the woman's regular course of living.

  • Drugs - In the initial stages, doctors often recommend anti-inflammatory medications, to help relieve the painful cramps during menstruation.
  • Hormone therapy - If painkillers do not work, doctors will advise hormone therapy in the form of oral contraceptive pills (in a tricyclic manner), which help control the hormones responsible for the buildup of endometrial tissue every month. Gonadotropin-releasing hormone analogue (GnRHa) injections may also be given, which block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This induces a state of pseudo-menopause thereby reducing the speed of proliferation of the endometriotic cells thereby alleviating the symptoms of pain. Whenever the woman wants to have children, the medication can be stopped and her ability to conceive will come back. Similarly oral tablets or intrauterine contraceptive device containing the progesterone hormone could also be used for symptomatic relief.
  • Laparoscopic surgery - Minimally invasive surgery helps a great deal in cases where the disease is in its advanced stages. These days, doctors successfully conduct key-hole surgery to remove as much endometriotic tissue as possible, while preserving the ovaries, uterus and the fallopian tubes. In severe cases, the ovaries might be damaged because of spread of the disease, thus hampering the woman's ability to have children. Assisted reproductive technologies, such as IUI and IVF come to the rescue of such couples and have been effective in fulfilling their dreams of having a child.
  • Hysterectomy - Sometimes, the disease might be quite extensive, and if the woman already has children, hysterectomy may be advised to totally remove the uterus and cervix and the ovaries. This treatment is usually considered as the last resort when all other methods fail. Ovaries may be conserved during hysterectomy should the woman be very young at the time of surgery ( < 40 years of age).


WHAT CAUSES ENDOMETRIOSIS?

WHAT CAUSES ENDOMETRIOSIS?

he disease has perplexed both scientists and medical professionals and there is no exact known cause for the disease. However, research has thrown up certain likely reasons for the development of endometriosis such as -

  • Backflow of menstrual blood or Retrograde menstruation - The commonest reason attributed for this disorder is backflow of the menstrual blood along with the endometrial tissue that has been shed from the uterus into the abdominal cavity through the fallopian tubes. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Genetic influence- Some women might be more likely than others to develop endometriosis because of their genetic pre-disposition. Those who have close relatives such as mother or sister suffering from the disease are more at risk of being affected by it themselves.
  • Surgical scar implantation - Endometriosis can develop as a result of endometrial cells attaching themselves to scar tissue following a surgery, such as a hysterectomy or Caesarean section and grow into lumps or cysts.
  • Embryonic cell growth - SThe cells lining the abdominal and pelvic cavities come from embryonic cells. When one or more small areas of the abdominal lining turn into endometrial tissue, endometriosis can develop.
  • Fast-paced lifestyle - Some studies of late, present the theory that certain lifestyle choices and the stress of modern living can contribute to the development of endometriosis. Environmental pollution, pesticides in our food and the increasing exposure to chemicals at home and around us may also be responsible but there is very little conclusive evidence to prove this.


Mrs. Bandana



Mrs. Binny Varghese


Dr. N


For Dr. N, it has been a long and painful battle with the disease, which affected her early in life. At a very young age itself, she had to grapple with debilitating pain in the lower abdomen during her menstrual periods and she also experienced heavy bleeding. Her life came to a standstill for those days as her pain would interfere in every aspect of her daily normal activities.

She went to many doctors but it was mostly put down to menstrual pain and she did not get much help. The first time she was asked to get a ovulation scan done, nothing showed up, so she did not receive any treatment. Dr. N suffered silently and went for another consultation only after she got married and when she and her husband were unable to conceive. This time after detailed investigations, she was diagnosed with endometriosis - she had chocolate cysts in her ovary. Laparoscopic surgery was done and when she was still unable to conceive, Intra-uterine insemination was done at the same place but it was unsuccessful. That is when she decided to come to Fortis and seek help from Dr Manisha Singh, at Fortis. It was found that the endometriosis had recurred and she was suggested to undergo further laparoscopic surgery. After a successful treatment she underwent IVF and this time there was good news. The couple were ecstatic with the news and are now the proud parents of a eight-month-old baby boy.

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Mrs. R


Mrs. R, a young free-spirited woman had not realized that endometriosis was behind her failure to get pregnant. She had thought that giving it time would make it happen as she was still young. But when the couple consulted Dr Manisha Singh at Fortis on the insistence of R's sister, she was diagnosed with PCOS and thyroid problems. She was asked to exercise and bring down her weight.

After that she was put on medications for infertility and started trying through her monitored natural cycles. But when this did not work, they were adviced to start Intra-Uterine Insemination. But the results were again negative. Mrs. R was shattered but got lot of support from her husband and Dr. Manisha and her team. After taking a break, she consulted the doctor again. At her next visit, she came face to face with a harsh reality - a scan detected that she had developed bilateral ovarian endometriomas (ovarian cysts). "The doctor advised me to undergo a Laparoscopic surgery for its excision. She gave us lot of strength and hope," says Mrs. R. The surgery was successful but it during the surgery it was found that her ovaries and left fallopian tube were badly affected. After three months of recovery, she underwent an ICSI cycle, and after a couple of failed attempts, she was able to conceive through a frozen embryo replacement cycle. Mrs. R says that Dr. Manisha and her team's never dying spirit and her husband's support made the impossible possible.

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